Respect for privacy and the case of Mr K

British Medical Journal, March 21, 1998 by Julian Savulescu, Rachel Marsden, Tony Hope

Patients who are in hospital for long periods may want the same level of privacy they have in their own homes. A clinical team from John Radcliffe Hospital Oxford describes the case of a young man with multiple sclerosis who was suspected of taking cannabis while in hospital for respite care. An ethicist, nurse, doctor, and manager from the Multiple Sclerosis Society give their views on the issue.

Respect for privacy and the case of Mr K

Julian Savulescu, Rachel Marsden, Tony Hope

In Britain, the patient's charter specifies standards of rights and dignity for patients. Little guidance is given about what this means in practice, other than the desirability of providing separate washing and toilet facilities for men and women in hospital. Respect for privacy, however, goes far beyond this. Here we consider the case of Mr K (box).

Hospitals and privacy

Privacy is often at risk in hospital. Patients may feel threatened if staff ask them unnecessarily personal questions or if parts of their bodies are exposed unnecessarily during physical examinations. Confidentiality, one aspect of privacy, can be breached when there is unwarranted access to facts about patients. Yet another side of privacy is the freedom to engage--in private--in activities that are important to us.

In this paper, we wish to highlight the importance of privacy in two groups of patients--those admitted to hospital with terminal diseases and chronically ill patients who spend long periods in hospital. For these people the hospital may be home, and they may need enough privacy to engage in important personal relationships and other activities that they value highly.

If hospital is home, attempts should be made to allow patients the same privacy they would enjoy at home. This includes providing space and time that are their own, so that they can do what they want, free from interference. Sexual relations between consenting adults would not necessarily be precluded. Important limitations to privacy exist, however, and special constraints apply in a hospital (box).

Privacy and the use of illicit drugs

Illegal behaviour raises further issues. Under section 8 of the Misuse of Drugs Act 1971, it is illegal for the occupier of a premises knowingly to permit the consumption of illicit drugs. The "occupier" refers to someone with the power to exclude people from the premises, and in a hospital this probably includes doctors and senior nurses. Health professionals may be in breach of the law if they knowingly allow the consumption of illegal drugs. However, an important difference exists between shutting one's eyes to an obvious breach of the law and respecting privacy.

Privacy is vitally important. The possibility that a patient may be consuming illegal drugs in hospital should not, by itself, justify invading their privacy, just as the possibility that patients might be using illicit drugs at home does not warrant unlimited access to their private lives.

In the case of Mr Et, it would be morally right to ensure that he and his mother are aware of the risks and benefits of using cannabis. But investigating whether the cake contains cannabis would be wrong unless staff believe that there is evidence of sufficient risk of harm to Mr K or to others that would justify intrusion into what is a private matter.

Conclusion

We expect privacy in our own homes and the right to behave in ways that others might disapprove of without interference. Healthcare professionals should provide such a level of privacy for patients who spend a long time or the end of their lives in hospital. For these patients privacy may be one of the few freedoms they can enjoy, and it is relevant to ask them how much privacy they would have in their own home. Good reasons are needed for accepting a lower level of privacy in hospital.

Mr K and the cannabis cake

* Mr K, a former carpenter and artist, is 35 years old. He has multiple sclerosis, which was diagnosed 10 years ago. Mr K has lived with his mother since his wife left him seven years ago. He needs full assistance with activities of daily living, and this is provided by his mother. Respite care is arranged at a rehabilitation hospital

* Mr K's mother asked if her son could smoke cannabis in the rehabilitation hospital. "He has stroked since he was a teenager. I was against it for a long time, but it's one of the few things he can enjoy now. He gets very agitated if he doesn't get his cop`, and his spasms are much worse." After consultation with colleagues, the ward sister told Mr K's mother that staff could not knowingly allow him to consume illegal substances on hospital premises

* Mr K was admitted to hospital. Every day his mother brought him a cake, which he ate with relish. One nurse suggested that the cake might contain cannabis. The staff were in a quandary; should they investigate further?

Limitations on patients' privacy in hospital

* Patients should not be free to pursue interests that harm or interfere with others. Private behaviour should not become public in a way that seriously offends others or incites others to break the law